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Transcript of doorstop interview: Adelaide: 7 March 2011: national health reform; mental health; PBS; Keith Hospital

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THE HON NICOLA ROXON MP Minister for Health and Ageing




JOHN HILL: Thank you all very much for being here this morning at Elpida, it's a really great day for mental health in South Australia, and I want to welcome to South Australia Nicola Roxon, the Federal Health Minister, Mark Butler of course, the South Australian who's the Federal Mental Health Minister, and Steve Georganas, who's the Member for Hindmarsh, which is where this facility we're in

today, is.

We're here to make an announcement about additional Commonwealth investment in our mental health services in South Australia, and I'm very pleased that Nicola and Mark are able to join me today to make these announcements.

Over the last few years, we have gone through a process of transformation of mental health care in South Australia. Until just three or four years ago, before the Stepping Up report was produced, and that's a report produced by Monsignor Cappo, mental health in South Australia was really languishing, we had a lot of hospital beds, acute beds, in fact we had, and still have, I think more acute places for mental health people in South Australia than per head of population anywhere else in Australia.

But that's about all we had, we didn't have very much in the community, we didn't have very much in the way of rehabilitation, such as this centre here, we didn't have places that people could go, other than hospital beds, and so we really tried to expand the range of opportunities, so fewer people have to go to a hospital, that there are other places they can go when they need help, so that they don't have to get into that really acute state, before they can get assistance, and when they're coming out of hospital, they've got somewhere to go, so they can get some support, so they don't end up in a situation where the acute episodes will recur.

So this example here is one such place, and we're building a number of these around our community, and there are other steps as well.

The announcement today is about putting in more places, finding more opportunities for people, mental health consumers in our community, sub-acute places, as we call them, but there's a variety of those sub-acute places, sub-acute beds, which Nicola will go - Mark will go through in a minute.

So I want to say on behalf of the public of South Australia, and the Government of South Australia, I'm very grateful for the Commonwealth's assistance, they have supported the initiatives that we have put on the table, so these aren't their ideas, these are our ideas, and they support the process of reform that we're

going through in South Australia, but they do coincide, I guess that's the right word, with the Federal Government's own ambitions, in terms of directing more effort into the mental health area.

This is all a part of the collaboration that exists between the State and the Federal Government, in the delivery of better health services for the public of South Australia.

So I do welcome Nicola and Mark and Steve here today, and I'll now invite, I think Nicola next, to say a few words.

NICOLA ROXON: Thanks very much, Mark and Steve and John, we're actually in Steve's seat, so thank you [indistinct]. You're obviously an advocate of the types of benefits a service like this can provide for the community.

Mark and I in particular are delighted to be here with Minister Hill, because today's announcement is about national health reform, delivering for South Australians.

We're able to announce today that as part of the National Health Reform package, 179 extra beds and places will be available, some in the community, some in facilities like these, to provide more options, particularly for those patients with mental health issues, who need a variety of different types of care, to enable them to be able to be settled back into the community, to give them support or respite in times of crisis.

And we're delighted that the South Australian Government has seen this national reform opportunity, and the funding that flows with it, as a way to expand services particularly for patients with mental health issues, but also as you'll see in the announcement, some investments in rehabilitation places as well.

Sub-acute care is not very well understood within the community, but these investments mean that many, many South Australians will now have more opportunities to have care more appropriately provided outside of a hospital, in a

setting closer to their home, with more community support, and giving them an opportunity often to re-establish their lives in a way which will allow them to move back into the community with broader support.

We see this as a very important part of health reform, we know that there needs to be investments in mental health services, we know that we need to provide settings for care that are more appropriate than our hospitals, and this is an opportunity to do that.

[Indistinct] …about meeting to deliver these benefits for South Australians, so there are 4 different projects which are being announced today, there will be 179 extra sub-acute beds, or places, across South Australia, providing that crucial mental health and rehabilitation care. This is $134 million of investments; the first investments were in health reform, including almost $80 million that will be dedicated to mental health projects.

So you can see that this is exciting for our government, federally, that the health reform deal that has now been struck with every state and territory, can be turned into investments, which South Australian patients can understand and appreciate.

Later today, I'm going to be going to a general practice, where we're talking to a very skilled GP, who's trained many other GPs throughout the course of his working life, and he's delighted that we are able to announce a 55 per cent increase in the number of GP training places here in South Australia, from the time when Mr Abbott was the Health Minister.

So this is all about our health reforms starting to hit the community, starting to deliver more benefits and services for the community, and we're happy to answer questions, but I think that this is basically the good news, of the difference that

health reform will make to the community, and I think Mark may want to make a couple of comments, just about the particular importance for mental health.

MARK BUTLER: Thank you, Nicola, thank you, John. This is a wonderful day, because I was a member of the board chaired by Monsignor Cappo that some years ago, in the Stepping Up report, identified precisely this type of intermediate care as being the major gap in service in South Australia.

What we see here today, through Commonwealth funding, as Nicola has said, is a type of care and support that someone who's spent significant time in acute settings, at Glenside or somewhere else, is able to access and step down from

acute care, eventually to be able to live independently in the community.

You've seen in there that they are quite different facilities to the sorts of facilities you see in acute settings, so people are able to reconnect with the ideas of cooking meals, washing clothes, hanging out clothes, making beds, doing all of

those things that are often skills lost in an extended period of time in an acute setting, and I think what Monsignor Cappo delivered to the State Government some years ago, a few years ago now, is precisely the vision that you can see before you today.

As I've travelled around the country, this is one of the major gaps that consumers, carers and service providers throughout Australia have identified in our mental health system, a gap that has emerged over the last 20 years or so, as we've tried to mainstream psychiatric services out of psych hospitals into general hospitals, so the vision of the State Government, in dedicating a lot of the sub-acute money that the Health Reform Agreement has provided them to mental health, is very, very welcome I think here in South Australia, and I think a

great example to other states as well.

NICOLA ROXON: Okay, over to you guys.

JOURNALIST: Minister, this national agreement was only signed last month, was this money as a result of that process, or was this quarantined before that?

NICOLA ROXON: Well, as you would be aware, South Australia was a very big advocate of our National Health Reforms, and was part of the deal that we were able to strike with all states and territories, except in Western Australia back in April last year.

So given that an agreement was reached with South Australia in April of 2010, we were already working on and identifying these projects with Minister Hill, and we're pleased now that we have the signatures of all premiers on this deal, that we are able to quickly roll out our investments here in South Australia, that we've been able to agree to these parts of the implementation plans, that money can flow, to enable these services to be up and running shortly.

So it has been a work that has continued, and of course it gives us the opportunity now that that deal has been finalised with all states and territories, to invest in these important services.

JOURNALIST: [Indistinct] this will mean effectively that patients pay more for medicines that are critical to them, how can you reconcile that, when the costs of medicines are already high?

NICOLA ROXON: Well, actually what this means is that the PBS, which provides millions and millions of Australians with very cheap access to medications, will continue to be sustainable into the future. Governments always have to make decisions in difficult financial and fiscal circumstances about how we prioritise our spending. We did list an additional 50 medications on the PBS. There are a number that we have made a decision to defer and in all cases but

one there are alternative treatments that are available for particular conditions and are listed on the PBS.

This is something that the government doesn't do lightly, but it is important for us to make sure that every health dollar is being well spent. We invest billions of dollars every year in the Pharmaceutical Benefits Scheme and it provides enormous support through providing cheap medications to millions and millions of Australians every week.

But that needs to be sustainable and that means when new requests are made for medications to be put on the PBS, they need to be rigorously assessed, not just by our expert advisers but also by the Cabinet and we need to make priority

decisions and that's what we've done.

JOURNALIST: On those expert advisers though, I mean are you ignoring the Pharmaceutical Benefits Advisory Committee by not listing some of these [indistinct]?

NICOLA ROXON: No, look absolutely not. The Pharmaceutical Benefits Advisory Committee plays a crucial role in assessing whether a medication is effective and cost-effective. What the Pharmaceutical Benefits Advisory Committee doesn't do and cannot do is make decisions which prioritise between government expenditure in times when fiscal circumstances are difficult. That's what the Cabinet is there to do. The Cabinet has always been part of that process before medications are listed on the PBS and that's the decision that Cabinet has made.

JOURNALIST: You say that there's a - not a very good understanding in the community of sub-acute care. Can you just explain what these beds will mean and are they actual beds or are we talking places? How will this work?

NICOLA ROXON: Sure, look, I'm happy to and I know that John may also want to make a comment on this. In our National Health Reform Agreement we've committed to 1300 extra beds that are sub-acute beds. What that means is it's - doesn't look like a bed which is in an intensive care unit in a hospital. It might be in a community. It might even be a hospital in the home type equivalent. It might be palliative care. It might be rehabilitative - rehabilitation care. It might be care for patients or consumers that have severe mental health issues.

So it's not your traditional idea of a bed. In some circumstances it will be but it's very important for us to understand that this has been a neglected part of the health system. Christine Bennett in her Health and Hospitals Reform Commission said that this was the missing link of care in Australia's otherwise very strong health system. And sub-acute means that you don't need all of the intensive care that is provided in a hospital setting but you do need a lot of support. Sometimes it won't even be clinical support. It might be life support,

which is required, as Mark's mentioned, teaching people again about cooking, looking after themselves, bathing themselves, things that are important to make sure people can reintegrate themselves back into the community.

And we think this is a very exciting part of making sure that we are dedicating our hospitals to care that can only be provided in hospitals and providing more options for people who need care outside the hospital system but often are not able to get it. So it's quite an exciting part of our health reforms. It is a new way of being able to provide care. It's been provided in settings like this in the past but it's expanding those options and we think that that's a real opportunity for South Australians to be able to get better care, more appropriately closer to their homes.

But do you want to comment on that John?

JOHN HILL: Look, thanks. I think this is a really interesting point. At - for some strange reason we describe capacity in hospitals in terms of beds. I suppose there's a logic to it but that's where patients spend the time when they're not really being treated often. It's the place where they sleep and where they stay when they're not mobile. In a - with a person who's got a mental health problem, of course they're not locked into a bed. They're mobile.

And the question is where's the best point in the - in their life journey for them to get care at a particular time and we know in various mental health conditions that patients go through a raising kind of level of need, and if you can get help to them at the earliest time then they don't end up needing a hospital bed. So that could be just having extra support in their home.

One of the things we're doing and we talked to a lady inside - she'll be leaving here in the next couple of months to go to - or in a couple of weeks I think - to go to a house in the community, what we're creating with, once again, with Commonwealth Government assistance, a couple of hundred houses which are being built, where mental health consumers can be placed and have care put into their home. And that may be people coming on a daily basis or a weekly basis or 24 hours a day, depending on their needs. So it's a range of things. So it's sometimes a little difficult to compare because there's a range of things that are happening.

One of the things we're announcing today amongst the issues is a special focus on youth. Pat McGorry has I think, made it very clear that he believes one of the priorities we should have across Australia is to focus on young people in that sort of 16 to 24 year old age group where he believes, and I think there's a lot of merit in what he's saying, if you can get early intervention before psychosis becomes ingrained in the behaviour of the people, you can actually do something to stop it becoming highly acute and allow people to continue on with their lives. So that's one of the focuses we have.

We're also expanding the number of places for forensic mental health patients as well because sadly that's a need that we have. So there's a range of things we're doing.

JOURNALIST: Minister when you see that say, as a result of this, what was perceived to be a bit of a mental health crush in some public hospitals, Flinders comes to mind, would that immediately alleviate it or is this further down the track for patients that would normally present themselves with other health …?

JOHN HILL: Well that's a good point you make I think Mike. One of the things - what we used to do in the past, we had two real institutions, if you go back 10 years, two institutions in South Australia which were for mental health patients, Glenside and Hillcrest. And a patient was assessed as having a mental health need and they'd be put in one of those institutions and like Sylvia said, she was there for 17 years. We now have a whole range of medications which allow better intervention so people who've got psychotic issues can actually be dealt with in a much more reasonable, much more rational way.

We've also tried to normalise mental health so it's not just seen as something which you put into an isolated area, put a big wall around it and say stay away, those people are dangerous. We've tried to - we're trying to say that people with mental health have health issues but lots of people have health issues and all hospitals should be available to people with health issues, whether it's mental health or a cancer or a heart or something else.

So we've created mental health beds in all of our metropolitan hospitals. And just as in the broader health area we're trying to find different places that people can get help other than hospitals, through our GP Plus and GP Super Clinic strategies with the Commonwealth again, we're creating extra places in the community where people can go.

Already we're seeing in South Australia as a result of some of these out of hospital reforms, we've seen a reduction in the growth. So there's still growth but it's reduced in the people attending emergency departments. Three or four years ago, when we started this program, our growth in emergency departments was about 5 per cent a year. We've now got it down below 2 per cent. That's a really good sign and I think we can do similar things with mental health.

But of course like all these things, it takes time. We have to get the infrastructure in place. We have here - we've got 3 of these kinds of services now. We've got other services that we've put in place and we'll expand those over the next - over the next little while. And with this assistance from the Commonwealth that will allow us to expand more rapidly than we otherwise would have.

FEMALE SPEAKER: And what about putting funding into, well the community and for people to apply for, for things like wheelchairs or things because for some

reason the health and the disability ageing sector are two completely different [inaudible]. And people like myself - I don't need a hospital bed. I don't need someone to talk to. I don't need any more medications. I need access and ability and it is the public ignorance and avoidance of wheelchairs, not just mental

health issues, that's you know, a very touchy subject.

But how is any of this - how is any of this money going to help people like me that worry about where am I going to get my next meal from because I live on a disability pension and after - after I've had my car and my rent and my phone stuff taken out, I have less than $800 for the entire year to eat, shop, go out, whatever. I have huge mental health issues with depression, stress and anxiety because I don't have any money to be able to go out to the pub and meet my friends for a drink.

JOHN HILL: Well, look, you've raised [inaudible]? Okay.

FEMALE SPEAKER: I - my wheelchair. I need a new wheelchair but you know Disability SA do not accept the fact that I'm not willing to give up the chair that I fought seven years for the measly $3000 for, to give it up for a week to get serviced and they'll give me a loan chair. I would not leave the house. But mental health and disability are two separate things.

JOHN HILL: Okay. Look, I appreciate what you're saying and I agree that - and if I can talk this way, but talk to you if I can, so the cameras can get what I say.

I think that the young lady makes a very good point. One of the things that we're working on at a national level and a state level is how we integrate our health services with other areas and the [inaudible] particularly important, aged care which Mark is responsible for, and disability services, trying to get an integration so that we can best manage the health needs of people who have got complex needs, whether it's mental health and - or disability or aged care. And some of our infrastructure does get - is not as flexible as it ought to be.

That's one of the reasons at a state level, we've asked Monsignor Cappo, who did the Stepping Up report, to now look at the issue of disability service to see how we can better manage those.

So I agree with you. There needs to be more done, and that's certainly a focus of our Government, and I know the Commonwealth Government is looking through a whole range of issues too in relation to disability services.

JOURNALIST: Minister Roxon, can I ask you about - you mention there that it's important for people to be able to get care closer to home. How do you feel about the potential for the closure of some smaller country hospitals in South Australia? I think your Shadow is down in Keith today having a look at the Keith

Hospital there, which has been having some disputes with the State Government over funding.

NICOLA ROXON: Well, look, obviously, I'm sure that Minister Hill will want to make some comments on that as well. What we are determined to do, through this national health reform process, is make sure that we do have health services that are sustainable into the future, and that's making sure that we're giving proper investments to the state governments, that we are structuring our investments in primary care in a better way, that we're looking at areas where there have been gaps.

Keith Hospital does have aged care places, so we do, through Mark's area, make investments in the hospital, and those investments are there and able to be continued. As I understand, it is a community private hospital, not a public hospital, so the levers that we have on that are minimal.

And I think that Mr Dutton could probably do better trying to tell the public what actually the Liberal Party would do when it comes to health reform. Mr Abbott and Mr Dutton have not told the public whether they will vote for this package of

reforms when it goes to the Parliament. They have not given one word of support to the billions of dollars of extra investments that are going in to our health system. They haven't made any comments about the sort of investments that we're announcing today.

So it's well and good to pick a couple of causes, and as I say, Minister Hill may want to comment on that. But ultimately, they have not provided the public with any proposal about what they would do with the health system. And they have got pretty poor form.

Mr Abbott and his government ripped one billion dollars out of our hospitals when he was Health Minister, he put a cap on GP training places, which we are now turning around with these additional investments. And they have not provided

one iota of support for any of those extra investments. So they have a little bit of a credibility gap to pick and choose turning up at a particular hospital to say it should be fixed, when they have provided no solutions themselves.

JOURNALIST: But, Minister, would the people of Keith say, well, what is the point of having this program to put more beds in the community if we're going to lose our hospital? And do you think the State Government should be putting the…

NICOLA ROXON: I think since the State Government is here, they may be able to speak for themselves.

JOHN HILL: Let me answer, then Nicola might want to comment on what I have to say.

Your question was based on an assumption that the hospital might close. I just reject that. I don't believe it will close. I don't believe it has to close. If it were to close, it would be because people made a decision to close it for political reasons, not for any other reasons.

We have talked to the hospital extensively over the last few months. We have had a close analysis of their expenditure. We have had a close analysis of their income. We believe that we can increase their income from the Commonwealth Government because they're not currently applying for the benefits from the Commonwealth Government through their aged care beds that they're entitled to, and that's in the tune of hundreds of thousands of dollars. We've pointed this out to them, and we've said we will help you try and work out how to maximise the amount of money you're getting from the Commonwealth Government.

We did with the other hospital that was involved in this - Ardrossan - and as a result of the assistance we've given them, they're now financially better off than they were before the funding cut from the Government was put in place. So we know that there is extra money there for them.

We have also looked at the way they operate the hospital, the kind of administrative overheads, the kind of staffing levels that they have, and we've compared it with what we would do if we were running a hospital of that size. And we said if you do what we would do, you can make some savings. And if they do both those things - make the savings and apply for the funds from the Commonwealth Government - they'll actually be financially better off than they are now.

In fact, in the case of Keith, since 2007, if you look at their annual reports and look at the information that's available, they have been trading in the red. Their day to day operations have been in the red. So it's not something that has happened just as a result of the last budget. This is something which has been systemic in that hospital over the last three or four years. It's up to the management of that hospital to make corrective actions, just as any private organisation would have to do to make itself sustainable. And we have offered to help them. We have offered to send people down who have got the skills to do the things that they don't necessarily have the skills to do. This is a board of well-meaning local people who are not experts in running hospitals and it's very difficult, I understand, for them to make some of these decisions. So we're happy to…

JOURNALIST: Minister, isn't that what the Commonwealth is talking about doing and the national reform is putting more local control in with hospitals?

NICOLA ROXON: Well, what we are talking about doing is making sure that we have local hospital networks that have a mix of skills, not the same as the

community board structure, a mix of skills using local clinicians, using business people, using those with expertise in health administration. And I think that really you have a different situation here, and Minister Hill has taken you through the particular circumstances.

We need to make sure that people don't politicise what is a serious issue for how you make a health service sustainable, whether it's in Keith, whether it's in any other part of the country. We're now providing important resources and working in partnership with our state and territory colleagues. We stand ready to assist in any way that is appropriate within the programs that we've got and the significant investments that we're making.

And as I say, I would urge Mr Dutton to make public what the Liberal Party's position is on health reform and health investments generally, not just pick and choose one hospital where he thinks a political point can be made.

JOURNALIST: I'd just like - a question on that. Regardless of what Minister Hill has said, there is still - the State Government is still taking money out of that hospital. And bearing in mind all that you said, is it appropriate for state governments to be taking money out of smaller community hospitals when…

NICOLA ROXON: Well, look, Minister Hill has answered those questions. It's appropriate for state governments to make decisions that they need to make to ensure that health services are sustainable. We're working with the South Australian Government and every other state and territory government to make

sure that we're investing sufficiently from the Commonwealth level to make sure that health services are provided to all South Australians.

And I think the news today of this millions of extra dollars that are going in to provide very important services, not just in Adelaide, but also in Mount Gambier, in Whyalla and elsewhere across the state, is cause for celebration, not criticism. And I think there's a good opportunity for us to continue to make sure that health reform delivers for all of South Australia.

JOURNALIST: Minister Roxon, why defer listings to the PBS when it really makes very little change to the bottom line of the budget and health is so important?

NICOLA ROXON: Well, I think, given the other questions that we're facing today, most people would not regard hundreds of millions of dollars as being very little change to the budget. They are significant investments. And there are hundreds and thousands of medications that are on the PBS. We have requests that come, that - when PBAC has done its work to Cabinet every couple of months. We will continue to scrutinise all of those proposals in the same way we scrutinise other proposals when people ask us to look at investments, whether it's in hospitals, whether it's in disability services, whether it's in, you know, any

range of areas. That is actually the job of Cabinet, to make sure that services are sustainable into the future and that we are supporting patients when they have particular needs, and that's what we'll continue to do.

JOHN HILL: Thanks, everyone.

NICOLA ROXON: Okay. Thanks very much.